Thoughts on the new Drug Strategy 2017 – Part 1 Overview and Reducing Demand

The Government published its new Drug Strategy on 14th July. It sets out “how the government and its partners, at local, national and international levels, will take new action to tackle drug misuse and the harms it causes.”

With his years of experience in this field here is the first in a series of reflective pieces from Will Johnston.

Overview

The Government’s much delayed drug strategy (originally mooted for 2015) has finally been published. Triumphant fanfares would have been misplaced to herald such document with a toot on a kazoo seeming more appropriate.

Anyone hoping for something revolutionary will have been disappointed – there’s no talk of decriminalisation or consumption rooms, no transfer of responsibility from the Home Office to the Department of Health.

Instead we have a glacially slow evolution that continues the themes of the 2010 strategy of “Reducing Demand”; “Restricting Supply”; and “Building Recovery”. There is new theme, “Global Action”, although this really seems to be a broad extension of “Restricting Supply”, setting out as it does an ambition for the UK “to be active around enforcement and promoting best practice in the global context”.

Reducing Demand

At first glance the identification of specific areas of action such as emerging substances (reinforcing the Psychoactive Substances Act 2016) and high priority vulnerable groups such as young people, offenders, veterans, sex workers, the homeless, older opiate users and those engaging in chemsex, can be seen as a positive development. However, this does assume that these groups are not already served by existing services.

The Strategy also assumes that there will be co-operation between different agencies and whilst this is the ideal, statements about partners working together to benefit such groups ignores some fundamental truths of attempting to work across multiple-partners, namely, that the benefits of any money spent must primarily be felt by those spending it.

This is an unintended consequence of dispensing with the established Pooled Treatment Budget (PTB) and moving funding streams to local authority public health teams and removing the ring-fence. The reality is that although it is glaringly obvious that strong partnerships are required to have any chance of success, partners will always put their own agendas first unless they’re paid to specifically undertake actions on behalf of others. If the primary role of the Police’s is to catch and charge, they will – they won’t identify and refer to appropriate services and have relied on variations of arrest referral models, historically funded by drug and Alcohol Action Team (DAATs) and latterly either by public health or Police Crime Commissioners, to make this happen, even though it ultimately contributes to reductions in reoffending, saving money for the police, courts and probation in the long-term. The same goes for housing, Hospital A&E departments or any other agency not directly commissioned by a local authority to work with drug users.

Looking further at one of the several priority groups, the government has quite rightly highlighted older, long-term opiate users with complex needs, however this also highlights the difference between the government’s words and desires and the realities of providing services. Success with this group will take different forms, but crucial to any progress is intensive support.

Funding reductions following the removal of the substance misuse ring-fenced element of the public health budget inevitably mean fewer resources for services. Fewer resources for services means there is no longer capacity to provide intensive 1-2-1 support for people with complex needs, instead leading to a greater reliance on a one-size fits all group approach, that many within the complex needs cohort do not favour, thus reducing chances of success.

Further examples of reality being out of step with aspiration are seen with the increase in drug related deaths, especially amongst older opiate users. We know that “Deaths involving heroin . . . more than doubled from 2012 to 2015” and it is no coincidence that this tragic increase in deaths followed the 2010 strategy that demonised harm reduction in favour of an almost evangelical adoption of recovery, ignoring the fact that harm reduction was in fact a crucial element in the recovery journey.

Furthermore, the statement that we need a “universal approach across the life-course” ignores the fact that former National Treatment Agency/Public Health England specialists used to exist specifically for this purpose. However, austerity driven restructuring has increased the breadth of individual portfolios & ultimately watered down the potential effectiveness of such roles.

The identification of specific groups goes at least some way to acknowledging the diversity and challenge faced by commissioners and services. When addressing these, what also needs to be considered is that individuals requiring services may well fall in to multiple categories, for example homeless veterans with mental health problems and a history of offending, who misuse over the counter meds, as well as traditional and emerging illegal substances. Public Health and government need to understand that achieving outcomes for such individuals takes time and patience and can be a frustrating process for all concerned; commissioners, services and service users, especially when assessments are required by each agency they access.